Performs care coordination duties to include primary care physician follow up appointments, home health, outpatient wound care clinic appointments, home IV antibiotics coordination.Works with physicians, patients, and their families to assist in facilitating a safe discharge plan to home or other levels of careMedical equipment ordering/coordination for home use such as wound vacs, hospital beds, mobility aides. as directed by the physician.Facilitates long term care facility admissions, short term rehab, inpatient rehab referrals.

Collaborates with physicians and other healthcare providers to ensure appropriate resource utilization for complex cases.

Educated physicians in risk coding Ran quality metrics reports to maintain high standards of virtual care. Employed by an Accountable Care Organization working as a consultant for assigned practices managing their population health/preventative care quality HEIDIS measures Assisted assigned clinics in managing patients preventative care regarding HEDIS and quality measure closure Quarterly, performs targeted quality assurance reviews of provider's documentation giving feedback regarding best practices Performed quality audits to close HEDIS measures and quality gaps and train staff regarding workflows to close them during patient encounter. Fostered strong relationships with providers, facilitating communication regarding patients'' preventative care needs and contributing to improved continuity of care. Supported the development of provider education materials focused on HEDIS measures and best practices in patient care. Served as a subject matter expert on HEDIS measures within interdisciplinary teams working on quality improvement initiatives. Trained new team members on HEDIS measures, clinical documentation requirements, and quality improvement strategies. Participated in regular meetings with management to discuss progress toward goals, challenges encountered, and potential solutions for enhancing performance outcomes. Improved the accuracy of HEDIS measures by meticulously reviewing medical records and identifying gaps in care. Analyzed electronic health records to identify areas for care improvement and cost reduction. Worked in this position until March 20, 2020 and was transferred to a chronic care management position as the result of COVID Managed preventative care for Medicare and Commercial patient population as a chronic care management nurse for assigned practices Provided staff training at assigned clinics in chronic care management and transitional care management as per CMS guidelines

Responsible for performing annual, periodic or other focused medical record audits to assess quality and accuracy of documentationConducted compliance related audits and monthly monitoring audits including EMTALA and narcotic prescribing for allPMC physicians to ensure PMC policy as well as CMS regulations were being followedCompleted management and employee interviews, PMC policy review as well all CMS, state and federal guidelines review in order to complete assigned auditsProvided detailed documentation on audit findings, facilitating swift corrective action when necessary.Mentored junior auditors, sharing knowledge and best practices to foster their professional growth within the team.Performed observations and evaluated supporting documents to supplement audit findings.Managed multiple concurrent audit engagements, prioritizing tasks to meet deadlines without compromising quality.Prepared written reports of the results of the audits along with proposed action planMeets with management and executives to review audit reports, discuss findings, and request corrective action plans.Completed medical record review daily to ensure documentation supported procedures billed and for charge capturePerformed defense audits representing the hospital when payers would deny chargesMonitored alert reports for bills that would not drop due to coding and or billing errors and worked with billing department to correct errorsAssisted the Risk department in monitoring records for employee or physician documentation omission as well as timely H&P submission by providersReviewed coding practices for consistency and accuracy, promoting appropriate reimbursement levels for services provided.Improved billing accuracy by conducting thorough medical record audits and identifying discrepancies in documentation.Enhanced compliance with healthcare regulations by diligently reviewing clinical records and ensuring adherence to guidelines.Assisted risk management in the appeals